Medicare Compliance & Reimbursement

Review HCPCS Level II blood product codes for differentiation.

Transfusions play a key role in treatment and care of patients for many Medicare providers. They are common in cancer treatments and can be administered pre- or post-surgery to replace lost blood. Plus, platelet transfusions can increase a patient’s platelet count when it drops dangerously low due to cancer or chemotherapy.

Understanding how to code transfusions and their component services is essential, no matter the specialty. To help you get it all right, here are four tips you can use every time you need to document these procedures.

Tip 1: Know How to Report the Transfusion

When a patient’s platelet counts are low, the patient may receive platelet transfusions as protection against bleeding. Additionally, the patient may receive red blood cell replacement to combat fatigue caused by chemotherapy-induced anemia or disease-induced anemia. When this occurs, you’ll code the simple transfusion using 36430 (Transfusion, blood or blood components), which is typical for an infusion involving patients other than newborns for partial exchange.

But remember, you can report the code “only one time per transfusion,” regardless of how many units of blood or blood products your provider transfuses (see CPT^® Assistant, Volume 3, Issue 11, page 10 (March 2001)). The Center for Medicare & Medicaid Services (CMS) offers medically unlikely edits (MUEs) and lists a limit of 1 for 36430, meaning that’s the maximum number of units the majority of patients should require.

Also, you should remember that “while there are various methods of blood transfusions — transfusion of homologous, autologous, or donor-directed blood — Medicare coverage does not make a distinction between them,” says Arlene Baril, MHA, RHIA, CHC, director of facility services for Pinnacle Enterprise Consulting Services in Dallas, Texas.

Billing alert 1: You won’t be able to bill separately for any supplies associated with the procedure. CPT^® guidelines for vascular injection procedures such as transfusions tell you that the services “include necessary local anesthesia, introduction of needles or catheter … and/or necessary pre- and post-injection care specifically related to the injection procedure.” For transfusions, billing also typically includes such supplies as central venous access devices, infusion pumps, blood warmers, rapid infusers, and pressure devices, for which you should not bill separately.

Billing alert 2: Transfusion of blood and/or blood products is only submitted with code 36430 when administered by a physician or qualified assistant employed by and under the supervision of a physician. Services rendered by an assistant would need to follow incident-to guidelines for Medicare patients and comply with other payer policies if required. Preparation of blood and blood products is included in the service for administration of the agent. Professional charges/ codes for the transfusion of blood or blood products should not be submitted when administered by hospital or home health agency personnel.

Tip 2: Know How to Report These Other Common Transfusions

For patient’s whose bone marrow is damaged and who cannot make red blood cells, white blood cells, and platelets that the body needs, you’ll report the stem cell transplant with either 38240 (Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor) or 38241 (… autologous transplantation).

For patients with sickle cell anemia or jaundice due to secondary liver cancer, your provider may perform an exchange transfusion. This differs from a regular transfusion in that it both adds and removes blood, so instead of 36430, you’ll use 36455 (Exchange transfusion, blood; other than newborn) for the procedure when performed on patients other than newborns.

Tip 3: Know How to Report Autologous Collection

Blood used in transfusions typically comes from an outside source, such as a community blood bank or a hospital. However, in cases when your practice performs autologous collection — the collection of blood from patients themselves — you can bill for both the process of collection along with the storage necessary to hold the blood until it is transfused into the patient using 86890 (Autologous blood or component, collection processing and storage; predeposited).

You might also be able to use 86891 (Autologous blood or component, collection processing and storage; intra- or postoperative salvage). The difference between the codes lies in the collection method: For 86891, the provider collects the patient’s blood, or components such as platelets, while the patient is undergoing surgery.

Don’t forget the Dx: In addition to reporting a code that documents the medical condition that has necessitated the patient’s transfusion, when patients donate their own blood, you’ll also use a code from Z52.01- (Autologous blood donor) depending on the kind of blood product produced from the donation. These could include whole blood (Z52.010), stem cells (Z52.011), or other blood products (Z52.018).

Tip 4: Know Your Blood Products and Procedures

Usually, you won’t bill for blood products your team administers during transfusion procedures as that is the prerogative of the blood supplier. When the blood is provided by a blood supplier, the supplier may not bill or receive direct payment from Medicare Part B in any setting for blood donation services (collection, processing, or storage of blood).

But you must remember to “report the blood products if you supply them,” says Baril. That means knowing the difference between the HCPCS Level II blood product codes if you are called on to fill out the patient’s UB-04. So, here’s a quick rundown of some of the different kinds of blood products you might encounter.

Whole blood “contains red cells, white cells, and platelets suspended in blood plasma” and is used “to treat patients who need all the components of blood, such as those who have sustained significant blood loss due to trauma or surgery,” according to the American Red Cross. Relevant codes for this product are P9010 (Blood (whole), for transfusion, per unit) and P9011 (Blood, split unit), which you will use whenever the patient takes the whole unit at different times.

Red blood cells (RBCs), also known as erythrocytes, are used for treating anemia and sickle cell disease, a blood disorder. You’ll use P9021 (Red blood cells, each unit) and P9022 (Red blood cells, washed, each unit) for a single red blood cell unit and possibly P9016 (Red blood cells, leukocytes reduced, each unit), which is a red cell blood product that further reduces the amount of white blood cells to help reduce rejection of the transfusion.

Platelets, “or thrombocytes, … are made in our bone marrow … [and] are most often used during cancer treatment … in order to treat a condition called thrombocytopenia,” according to the American Red Cross. In addition to the basic codes P9019 (Platelets, each unit) and P9020 (Platelet rich plasma, each unit), your code choices here describe processes such as irradiation, which reduces infections in patients susceptible to infections, and/or pheresis, where the patient’s blood is removed, processed into platelets, and returned to the patient.

• Choices for irradiated platelet blood products include:
• P9032 (Platelets, irradiated, each unit)
• P9033 (Platelets, leukocytes reduced, irradiated, each unit)

Pheresis codes include:

• P9034 (Platelets, pheresis, each unit)
• P9035 (… leukocytes reduced, each unit)
• P9036 (… irradiated, each unit)
• P9037 (… leukocytes reduced, irradiated, each unit)

Reminder: Plasma is the liquid that contains all the blood cells and platelets. This product, coded with P9025 (Plasma, cryoprecipitate reduced, pathogen reduced, each unit), is often used for treating patients with blood clotting disorders.

Cryoprecipitated (cryo) blood products are an extension of plasma products made especially for patients with hereditary blood clotting conditions such as hemophilia and von Willebrand disease. Here, code options include P9012 (Cryoprecipitate, each unit) and P9026 (Cryoprecipitated fibrinogen complex, pathogen reduced, each unit).